RESUMO
A 15-year-old non-diabetic Caucasian girl presented with sudden onset of seizures, unrecordable blood glucose readings and acute renal failure. She denied any medication ingestion and no other precipitating factors were encountered for this acute presentation. She was treated with intravenous glucose infusion and hydrocortisone injection. Investigations showed a non-ketotic hypoglycaemia with high C-peptide and insulin levels. It took several days and multiple investigations to establish the exact cause of her persistent hypoglycaemia before it was concluded to be secondary to gliclazide overdose in a suicide attempt by the young girl. She made a complete recovery in a week with no apparent lasting neurological or renal impairment.
Assuntos
Gliclazida/intoxicação , Hipoglicemia/induzido quimicamente , Hipoglicemiantes/intoxicação , Convulsões/induzido quimicamente , Convulsões/diagnóstico , Adolescente , Glicemia/análise , Diagnóstico Diferencial , Overdose de Drogas/urina , Serviço Hospitalar de Emergência , Feminino , Gliclazida/administração & dosagem , Gliclazida/urina , Glucose/administração & dosagem , Glucose/uso terapêutico , Humanos , Hidrocortisona/administração & dosagem , Hidrocortisona/uso terapêutico , Hipoglicemia/complicações , Hipoglicemia/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Infusões Intravenosas , Insulina/sangue , Convulsões/complicações , Tentativa de Suicídio/psicologia , Resultado do TratamentoRESUMO
The hypoglycemic action and disposition of gliclazide, an oral antidiabetic drug, was investigated in normal and analbuminemic rats. Orally administered gliclazide exhibited a stronger hypoglycemic action in analbuminemic rats than in normal rats. However, the plasma concentration of the drug in the mutant was much lower than that in the normal. This apparent discrepancy may be clarified by measuring the plasma concentration of unbound gliclazide. Analbuminemic rats gave larger values for the total body clearance and steady state volume of distribution of gliclazide than normal rats. The biliary and urinary excretion rates of radioactivity after intravenous bolus administration of [3H]-gliclazide were much greater in the mutant than in the normal. The binding of gliclazide to serum in analbuminemic rats was much lower than that in normal rats. Furthermore, the radioactivities of some tissues after oral administration of [3H]-gliclazide were found to be significantly higher in the mutant than in the normal. These results clearly indicate that albumin plays an important role in the hypoglycemic activity and disposition of gliclazide in rats.
